With children under 5 likely to be cleared for the coronavirus vaccine in the coming weeks, local officials are making plans for how the vaccine will be distributed to babies and toddlers — but the rollout will pose extra logistical hurdles, including the need for more doctors to enroll as vaccine providers.

Pharmacies, which have been a major part of the vaccine distribution process, can only vaccinate kids 3 and up under federal rules. But many doctors, who immunize babies and toddlers against other illnesses, aren’t signed up to administer the COVID-19 vaccine.

That presents what Philadelphia Health Commissioner Cheryl Bettigole last week called an “infrastructure problem.” Public health leaders who need to ensure the vaccine is accessible to all residents are trying to get more pediatricians signed up to give shots and planning for a rollout that has to accommodate the youngest members of society.

“The rollout for that vaccine,” Bettigole said at a recent briefing, “will be quite different than what we’ve been doing over the last 13 months.”

Federal regulators are set to discuss Pfizer’s two-dose vaccine for children under 5, which can be administered starting at 6 months old, next week. Approval could come as soon as March.

The approval would be a milestone, making protection against the coronavirus available for all ages, save for newborns. It also promises long-awaited relief for parents of young children, though the two-dose regimen wasn’t as effective in trials as the vaccine for adults. Results of a study examining a third dose are pending; doctors said they recommend parents start the first doses as soon as they can.

The omicron surge brought higher infection rates among children than in previous surges: In January alone, more than 3.5 million U.S. children were infected. Children generally get only mild cases of the virus. But public health officials say vaccinating them is key to protecting others they come in contact with, including immunocompromised classmates and high-risk adults, such as grandparents.

The number of children 5 to 11 getting vaccinated has been lower than public health officials hoped for, heightening concern about whether parents will balk at under-5 immunization and adding urgency to rollout plans and education efforts.

» READ MORE: Less than a third of Pa. and N.J. elementary schoolers have been vaccinated against COVID-19, three months since the shot became available

“We need all the help that we can get to inform parents of the desirability of immunizing as many children as we can as soon as we can,” said David Cooper, a physician and co-owner of Chester County Pediatrics.

Enrolling doctors

Before children under 5 become eligible, Philadelphia, Pennsylvania, New Jersey, and Delaware health officials are working on signing up more pediatricians and family doctors to deliver vaccines. Many practitioners didn’t sign up initially because the doses needed ultra-cold storage, but now they can be stored for several weeks without special equipment.

The state and city don’t have exact counts of how many doctors are administering shots. A large health-care system registers as one provider, for example, but can distribute vaccines to its many practitioners.

About 3,600 provider locations are enrolled in Pennsylvania, about 780 of which are family medicine or pediatric practices, according to the state. In Philadelphia, 70 providers in the Vaccines for Children program, which helps doctors administer routine immunizations, are enrolled to do COVID-19 shots.

The Pennsylvania Department of Health is working with primary care physicians to enroll them in the program “as soon as possible,” said department spokesperson Mark O’Neill. “The more providers that have the product available for administration, the better.”

New Jersey health officials plan to announce more details about the rollout to kids under 5 in coming weeks. Delaware health officials will use their existing network, including pediatricians’ offices and pharmacies, a spokesperson said.

Since children 5 and older became eligible for the shots in November, not all families have found shots at their doctors’ offices.

Cooper said his office sees children referred from pediatric offices that aren’t providing the shots.

“I find that very depressing,” he said.

City health officials have asked the CDC whether they can legally loosen the strict reporting requirements for smaller doctors’ offices to help make the process less onerous, said health department spokesperson James Garrow.

The city’s planning isn’t focused on mass clinics “due to the difficulty of vaccinating small children and the dearth of health-care professionals with the skills to do that,” Garrow said.

“I’d love to see kids getting these vaccines at their normal pediatric visits,” Bettigole said at a recent briefing.

Ensuring access

But not all doctors have the logistical or staffing capability to do the shots, prompting concerns about equitable access.

“If you don’t have enough of your pediatricians that’s able to give the shot for various reasons, then the city has to try to work to have locations set up where parents can take their children,” said Philadelphia pediatrician Elana McDonald. “You have to make it readily available, especially in the neighborhoods with the highest poverty rates.”

Nearly 20% of children under 5 nationally live below the poverty line and more than half are people of color, for whom the pandemic has exacerbated historic inequities in health care. And among many parents of all demographics, even among some who got vaccinated, hesitancy about the shot remains pervasive, with only about 3 in 10 nationwide planning to get their under-5-year-olds vaccinated right away, a Kaiser Family Foundation poll found.

» READ MORE: Some people’s minds are changing about the coronavirus vaccine. Here’s how doctors persuade them.

Cooper, the pediatrician in Exton, said his biggest worry isn’t logistical — his greater concern is that many children won’t come in for shots.

In some places, including communities of color and rural areas, hesitancy could be exacerbated by the absence of pharmacies. Some people who might not regularly see a physician have established relationships with local pharmacists who fill their prescriptions. Providers are also concerned about vaccine access for families who don’t regularly have contact with any health professionals.

“I worry more about people who don’t have pediatricians,” said Chichi Ilonzo Momah, chief operating officer and pharmacist-in-charge at Springfield Pharmacy in Delaware County. “I worry about people who don’t have insurance and don’t even realize these vaccines are free.”

At the outset, vaccine access could generally be low — it’s likely there will be a limited amount available at first, Garrow said, making it more difficult to find appointments.

Meanwhile, many pharmacists are planning to help the effort by vaccinating 3- and 4-year-olds, said Victoria Elliott, chief executive officer the Pennsylvania Pharmacists Association. At Skippack Pharmacy, for instance, pharmacist Mayank Amin said he was getting his staff trained for toddlers.

At Springfield Pharmacy, Momah expanded into a second storefront just to give vaccinations when 5- to 11-year-olds became eligible. There’s more space, so parents and siblings can easily join them. She’s thinking about how she’ll greet the under-5 contingent when it’s their turn.

“We’re planning and trying to get creative on how to cater to that age group and also to their families and their parents,” Momah said. “Because they’re going to be afraid. No one likes to get shots.”